Monthly Archives: April 2018

Bariatric science, is an emerging science that has progressed and developed diagnostic tools that can accurately determine an individual’s energy (calorie) needs as well as quantify their metabolic efficiency. The Resting Metabolic Rate test (RMR), and our ability to interpret the results, allows weight management to be an empirical science. This noninvasive 10 min. breathing test, accurately measures an individual’s energy needs and their specific rate of metabolism referred to as metabolic factor (MF).

These are physical metrics that bariatric health specialists can use to determine individual weight-loss and weight stabilization dietary plans. It provides an opportunity to predict an individual’s energy needs at the weight they choose as their goal; which may or may not realistic based on their MF. It also offers an opportunity to explain variability in losses and gains and surgeons can use these metrics when choosing an appropriate surgical procedure.

When a patient that has continually been plagued with “the slings and arrows” of lifelong obesity, discovers that they have a very low metabolic factor (hypo-metabolic) and likely the primary cause of their obesity….this test can begin to relieve a good deal of the shame and self-blame that has riddled their lives. Metabolic science can be shared with patients and even used as part of cognitive behavioral programs.

Seemingly a “numbers game” and only a physiological metric. Hopefully by watching the video tutorial (below) you will recognize the plethora of biopsychosocial implications. For bariatric professionals, not using RMR/MF testing would be like treating hypertension without measuring blood pressure or diabetes without measuring glucose.

Tutorial: Interpreting Metabolism (RMR/MF)

AABC Research Fellows Identify “The Missing Link”. A New And Important Metric, In Understanding Why Some People Are Thin And Others Thick Despite Similar Caloric Intake.

The American Association of Bariatric Counselors is pleased to announce that two of their research fellows have completed an important bariatric science research project that identifies a primary cause of a most prevalent category of obesity.
The researchers, Dr. Brandon Davis from Grinnell Iowa and Dr. Joseph Indelicato from Queens, NY have recently been informed that their manuscript entitled "Stability of Metabolic Factor Before and After Bariatric Surgery" will be published in Obesity Surgery, the official journal of the International Federation for the Surgery of Obesity and Metabolic Disorders and is currently available online at: http://bit.ly/MetabolicFactorAABC

Dr. Brandon Davis

Lead researcher, Dr. Davis, a psychologist and Board Certified Bariatric Counselor commented, “Our research has identified a new metric that we call the Metabolic Factor, which can be thought of as the missing link in understanding why some folks are thin and others thick despite similar caloric intake. It can also explain why many dieters and bariatric surgery patients relapse and regain weight lost. Obese individuals with a low metabolic factor (hypo-metabolic) lend support to a genetic predisposition to a very prevalent category of obesity. The tools and the methodology we developed to diagnose and quantify an individual’s Metabolic Factor are currently available. This study's findings indicate that Metabolic Factor seems to be a stable characteristic within a person despite significant weight loss. We expect this discovery to be a game changer in the understanding of obesities and helping patients and bariatric health professionals make informed choices regarding care and treatment.”

Dr. Joseph Indelicato

Dr. Indelicato, a professor at Touro College/University System and AABC Research Director noted, “For Bariatric Surgeons treating based on an individual’s Metabolic Factor, it is an essential metric for selecting an appropriate surgical procedure for each patient and thereby improving long-term, post-surgical weight loss and surgical procedure efficacy.”
Both researchers agree that perhaps a most important contribution of this discovery is the potential to reduce societal stigma and shame associated with obesities. Board Certified Bariatric Professionals are already licensed/certified health and education professionals. They include medical doctors, educators, psychologists, nurses, nutritionists and other disciplines that engage in research, diagnosis, treatment and prevention of obesities and related disorders.
Click to view video

Female research partners; one a biochemist who weighed 250lbs (Lifelong obesity) and the other an endocrinologist who has always weighed 135lbs (since her teens). We performed their RMR tests; The endocrinologist’s RMR was 1485 Kcal per day. The biochemist RMR was 1500 Kcal per day. Both expend almost identical Kcal per day (1485/1500) and if they replace their expended calories with food they would remain at the same weight.
Despite one being thin and the other thick, they consume the same amount of calories. However, if you divide their individual RMRs by their weights:
Endocrinologist: 1485/135lbs = 11 (MF)
Biochemist: 1500/250lbs = 6 (MF)
The endocrinologist has a MF of 11 (which is in typical range) and likely predisposed her to be thin (135lbs). The biochemist has a MF of 6 which is very low (hypometabolic) and likely predisposed her to obesity (250lbs).You could say one has 6 cylinders and the other 11 cylinders. Needless to say, you use more gasoline (energy) if you have 11 cylinders.
We reviewed the test results with these friends and colleagues. The thin endocrinologist’s guilt fully addressed her friend; "I always privately believed you did not care about yourself, you were lazy and responsible for your own girth." She then told her how terribly sorry she was for her unfounded beliefs. You might say that this test helped both overcome irrational belief systems.
This is a shining example of how a numeric physiological test had profound psychosocial implications. It is up to us to use “best practices” in bariatric science (mind and body) and not get caught up in the science of public consensus.

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Debra Gwynn, MA, LMFT, a licensed marriage and family therapist from Eustis, Florida, has been awarded National Board Certification by the American Association of Bariatric Counselors (AABC). After completing a specialized training and education program in bariatric science she was recently credentialed as a Board Certified Bariatric Counselor (CBC).

Ms. Gwynn received her master’s degree and professional training at Rollins College and currently has a private practice in Mount Dora, Florida. For almost 10 years she has specialized in working with individuals, couples, and families. Debra has acknowledged that the mind and body are indivisible and best practices in therapeutic care requires competency in biology as well as psychology. This knowledge and years of personal and professional experiences led her to an interest in bariatric science and weight management.

In addition to her private practice she provides the required supervision and mentoring for both Mental Health Counselor and Marriage and Family Therapist interns.

Her recognition of the link between mental distress and obesity and the need for specialized competency in bariatric science inspired her post-graduate training and certification with AABC. Her clinical experience, scholarship and commitment to public health will further the AABC global mission of providing best practices in the care and treatment of those suffering from obesity and related disorders.

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Charles Cox a licensed Clinical Social Worker (LCSW) in private practice located in Baldwin, N.Y., has been awarded National Board Certification by the American Association of Bariatric Counselors (AABC). After completing a specialized training and education program in bariatric science he was credentialed as a Board Certified Bariatric Counselor (CBC).

Mr. Cox received his master’s degree in social work (MSW) from Stony Brook University and has 19 years of clinical psychotherapy experience in multiple settings. His scope of practice ranges from pediatrics to geriatrics. He has provided mental health services within the NYC Division of Child Protection, in children and adult mental health clinics as well as providing psychotherapy home-care for seniors. In his private practice he has identified a link between obesity and mental illness which led to his specialization in bariatric counseling.
His recognition of a dual diagnosis of mental illness and obesity and the need for specialized competency in bariatric science inspired his post-graduate training and certification with AABC. His clinical experience, scholarship and commitment to public health will further the AABC global mission of providing best practices in the care and treatment of those suffering from obesity and related disorders.

Sara Atallah, a licensed clinical dietitian/nutritionist from Riyadh, Saudi Arabia, has been awarded Board Certification by the American Association of Bariatric Counselors (AABC). After completing a specialized training and education program in bariatric science she was recently credentialed as a Board Certified Bariatric Counselor (CBC).

Chelsea Capella Johnson, MS, RD, LD, a registered and licensed dietitian from Houston, Texas, has been awarded Board Certification by the American Association of Bariatric
Counselors (AABC). After completing a specialized training and education program in bariatric science she was recently credentialed as a Board Certified Bariatric Counselor (CBC).

Ms. Johnson currently serves as a clinical dietitian/nutritionist at Memorial Hermann Memorial City Medical Center in Houston. She is an integral member of their NewStart program’s interdisciplinary team that is committed to helping individuals overcome obesity. Treatment modalities include nutrition counseling, support programs as well as bariatric surgeries.

Her professional education includes a Bachelor of Science in Nutrition from the University of Texas in Austin, a dietetic internship at the Michael E. Debakey Veterans Affairs Medical Center in Houston, and a Master of Science in Nutrition from Texas Woman’s University in Houston.

Recognition of the obesity pandemic and the need for specialized competency in bariatric science inspired her post-graduate training and certification with AABC. Her clinical experience, scholarship and commitment to public health will further the AABC global mission of providing best practices in the care and treatment of those suffering from obesity and related disorders.

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As Bariatric Professionals, I think we can all agree that health and happiness is more than a number on scale.

Having a sense of inner peace, pride and self-worth, being loved, prized, earning the respect and approval of others, these are some of the basic human conditions inherent in happiness.

But by being “fat” in a hostile weightism culture, by default, you are not entitled to these inherent human conditions of happiness. Our cultural distain for obesity simply does not allow obese people to be happy.

This is the unspoken tormenting psychological burden that many/most patients endure and a very powerful motive for wanting to escape obesity.

Is our job merely to help them attain their aesthetic ideals so they could finally win the approval of the very same culture that created the social injustice of weightism? Isn’t it also our job to right the wrong of this injustice? If we are to be the professional and caring agents of change our focus requires attention to their happiness and wellbeing and not just their weight.

Obesity is a chronic condition and many patients (surgical or non-surgical), will not be able to permanently lose weight under our care. But by prizing patients at every size, what we can help them lose is the tormenting psychological burden of the injustice of weightism. Health and happiness in not a number on a scale.

Excerpts from: The Weight Of The Nation: Stigma- The Human Cost of Obesity